Citation Nr: 0820480
Decision Date: 06/23/08 Archive Date: 06/30/08
DOCKET NO. 05-35 683 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Newark, New
Jersey
THE ISSUES
1. Entitlement to service connection for bilateral hearing
loss.
2. Entitlement to an increased (compensable) rating for
residuals of an infected right leg.
3. Entitlement to an increased (compensable) rating for
residuals of a left ankle fracture.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
T. Hal Smith, Counsel
INTRODUCTION
The veteran served on active duty from November 1942 to
January 1946.
This matter is before the Board of Veterans' Appeals (Board)
on appeal of a September 2004 rating decision of the
Department of Veteran's Affairs (VA) Regional Office (RO) in
Newark New Jersey.
This matter was Advanced on the Board's docket pursuant to
38 C.F.R. § 20.900.
FINDINGS OF FACT
1. A hearing loss disability was not manifested in service
or within the veteran's first postservice year; and a
preponderance of the evidence is against a finding that his
bilateral hearing loss disability is related to his service;
the veteran declined to report for a scheduled VA audiometric
examination in conjunction with his claim. Thus, it is not
possible to ascertain whether there is hearing loss for VA
purposes.
2. The veteran's residual scar of the right leg is not shown
to limit the function or motion of the right leg, is
superficial, is neither unstable nor deep, and is not shown
to be painful on examination. No active infection is
demonstrated
3. The veteran's left ankle disability is manifested by
complaints of pain and instability, but with no objective
confirmation of limitation of motion, pain, or instability.
CONCLUSIONS OF LAW
1. Service connection for bilateral hearing loss is not
warranted. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5102,
5102A, 5103, 5107, 5108 (West 2002 & Supp. 2007); 38 C.F.R.
§§ 3.102, 3.303, 3.307, 3.309, 3.385, 3.655 (2007).
2. The criteria for a compensable rating for a residual scar
of an infected right leg are not met. 38 U.S.C.A. §§ 1155,
5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§
3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.10, 4.31, 4.118,
Diagnostic Codes (DC) 7803, 7804, 7805 (2007).
3. The criteria for a compensable disability rating for
residuals of a left ankle fracture have not been met. 38
U.S.C.A. §§ 1155, 5102, 5102A, 5103, 5107 (West 2002 & Supp.
2007); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.40, 4.45, 4.71a,
DC 5271 (2007).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
Duties to Notify and Assist
The Veterans Claims Assistance Act of 2000 (VCAA), codified
in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented at
38 C.F.R. § 3.159, amended VA's duties to notify and assist a
claimant in developing the information and evidence necessary
to substantiate a claim.
First, VA has a duty under the VCAA to notify a claimant and
any designated representative of the information and evidence
needed to substantiate a claim. In this regard, July 2004
and January 2006 letters to the veteran from the RO
specifically notified him of the substance of the VCAA,
including the type of evidence necessary to establish
entitlement to service connection on a direct and presumptive
basis, and of the division of responsibility between the
veteran and the VA for obtaining that evidence. Consistent
with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), VA
essentially satisfied the notification requirements of the
VCAA by way of these letters by: (1) informing the veteran
about the information and evidence not of record that was
necessary to substantiate his claims; (2) informing the
veteran about the information and evidence VA would seek to
provide; (3) informing the veteran about the information and
evidence he was expected to provide; and (4) requesting the
veteran to provide any information or evidence in his
possession that pertained to the claims.
Second, VA has made reasonable efforts to assist the veteran
in obtaining evidence necessary to substantiate his claims.
38 U.S.C.A. § 5103A (West 2002 & Supp. 2007). The
information and evidence associated with the claims file
consist of the veteran's service treatment records, VA
medical treatment records, to include examination reports,
and statements from the veteran and his representative.
There is no indication that there is any additional relevant
evidence to be obtained by either VA or the veteran.
The United States Court of Appeals for Veterans Claims
(Court) held that the notice requirements of 38 U.S.C.A.
§ 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements
of a service connection claim, to specifically include that a
disability rating and an effective date will be assigned if
service connection is awarded. Dingess v. Nicholson, 19 Vet.
App. 473 (2006). In the present appeal, the veteran was
provided with notice of this information in a letter dated in
June 2006.
VA regulations provide that when a claimant fails to report
for a scheduled medical examination, without good cause, an
original compensation claim shall be rated based upon the
evidence of record. See 38 C.F.R. § 3.655 (2007). The Court
has also held that VA's "duty to assist is not always a one-
way street." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).
If a veteran wishes help, he cannot passively wait for it in
those circumstances where he may or should have information
that is essential in obtaining relevant evidence.
Correspondence from the veteran's service representative
dated in June 2006 includes a request for a remand in this
decision so that additional VA testing can be accomplished.
However, the record shows that while the veteran appeared for
VA exams in 2004, to include evaluation of the ear, he failed
to report for audiometric testing that same day. The Board
finds good cause has not been shown for this failure to
report and that further attempts to obtain additional
evidence would be futile or unnecessary. Therefore, the
claim must be decided based upon the available medical
evidence. There has been substantial compliance with all
pertinent VA law and regulations and to move forward with the
claim would not cause any prejudice to the appellant.
In his substantive appeal he indicated that he had undergone
a hearing test at East Orange. He was asked to provide the
date of that testing and did not do so. Thus, it is
concluded he is making reference to the August 2004
examination noted above.
As to the increased compensation claims, section § 5103(a)
requires, at a minimum, that the Secretary notify the
claimant that, to substantiate a claim, the claimant must
provide, or ask the Secretary to obtain, medical or lay
evidence demonstrating a worsening or increase in severity of
the disability and the effect that worsening has on the
claimant's employment and daily life. Vazquez-Flores v.
Peake, 22 Vet. App. 37 (2008). Further, if the DC under
which the claimant is rated contains criteria necessary for
entitlement to a higher disability rating that would not be
satisfied by the claimant demonstrating a noticeable
worsening or increase in severity of the disability and the
effect that worsening has on the claimant's employment and
daily life (such as a specific measurement or test result),
the Secretary must provide at least general notice of that
requirement to the claimant. Additionally, the claimant must
be notified that, should an increase in disability be found,
a disability rating will be determined by applying relevant
DCs, which typically provide for a range in severity of a
particular disability from noncompensable to as much as 100
percent (depending on the disability involved), based n the
nature of the symptoms of the condition for which disability
compensation is being sought, their severity and duration,
and their impact upon employment and daily life. As with
proper notice for an initial disability rating and consistent
with the statutory and regulatory history, the notice must
also provide examples of the types of medical and lay
evidence that the claimant may submit (or ask the Secretary
to obtain) that are relevant to establish entitlement to an
increased compensable -e.g., competent lay statement
describing symptoms, medical and hospitalization records,
medical statement, employer statement, job application
rejections, and any other evidence showing an increase in the
disability or exceptional circumstances relating to the
disability. Vazquez-Flores, supra.
Here, the VCAA letters mentioned above notified the veteran
that the question of whether a compensable rating was
warranted for service-connected right leg and left ankle
conditions would be determined by reviewing the evidence and
determining if either condition had worsened. The veteran
was not told that the clinical findings would be applied to
relevant DCs, which typically provide for a range in severity
of a particular disability from noncompensable to as much as
100 percent, and that VA would consider evidence that
documented the nature and symptoms of the condition, severity
and duration of the symptoms, and impact of the condition and
symptoms on his employment. There was no reference to the
diagnostic criteria for establishing a higher rating.
In Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007), the
United States Court of Appeals for the Federal Circuit held
that any error by VA in providing the notice required by 38
U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b)(1) is presumed
prejudicial, and that once an error is identified as to any
of the four notice elements the burden shifts to VA to
demonstrate that the error was not prejudicial to the
appellant. The Federal Circuit stated that requiring an
appellant to demonstrate prejudice as a result of any notice
error is inconsistent with the purposes of both the VCAA and
VA's uniquely pro-claimant benefits system.
Instead, the Federal Circuit held in Sanders that all VCAA
notice errors are presumed prejudicial and require reversal
unless VA can show that the error did not affect the
essential fairness of the adjudication. To do this, VA must
show that the purpose of the notice was not frustrated, such
as by demonstrating: (1) that any defect was cured by actual
knowledge on the part of the claimant, see Vazquez-Flores v.
Peake, supra ("Actual knowledge is established by statements
or actions by the claimant or the claimant's representative
that demonstrate an awareness of what was necessary to
substantiate his or her claim.") (citing Dalton v. Nicholson,
21 Vet. App. 23, 30-31 (2007)); (2) that a reasonable person
could be expected to understand from the notice what was
needed; or (3) that a benefit could not have been awarded as
a matter of law. Sanders, 487 F.3d at 889. Additionally,
consideration also should be given to "whether the post-
adjudicatory notice and opportunity to develop the case that
is provided during the extensive administrative appellate
proceedings leading to the final Board decision and final
Agency adjudication of the claim ... served to render any
pre-adjudicatory section 5103(a) notice error non-
prejudicial." Vazquez-Flores v. Peake, supra.
In this case, the Board finds that any notice error did not
affect the essential fairness of the adjudication. The
veteran clearly had actual knowledge of what was necessary to
substantiate his claim. His statements demonstrate this
awareness. Accordingly, the Board finds that the essential
fairness was maintained in this case as the claimant
demonstrated an understanding of the evidence required to
substantiate the higher ratings sought and that a higher
rating would be assigned based on the pertinent diagnostic
criteria. The claimant discussed the pertinent criteria and
submitted supporting evidence. The criteria were discussed
in the statement of the case (SOC), and reasons as to why a
higher rating was not warranted under that criteria were
identified.
The veteran's pertinent medical records have been obtained,
to the extent available. 38 U.S.C.A. § 5103A (West 2002 &
Supp. 2007); 38 C.F.R. § 3.159 (2007). There is no
indication in the record that any additional evidence,
relevant to the issue decided herein, is available and not
part of the claims file. There is no objective evidence
indicating that there has been a material change in the
service-connected conditions since the claimant was last
examined. 38 C.F.R. § 3.327(a). The duty to assist does not
require that a claim be remanded solely because of the
passage of time since an otherwise adequate VA examination
was conducted. See VAOPGCPREC 11-95. The VA examination
reports are thorough and supported by VA outpatient treatment
records. The examination in this case is adequate upon which
to base a decision. The records satisfy 38 C.F.R. § 3.326.
With respect to the duty to assist, the Board notes that the
veteran has undergone a VA examination in conjunction with
his claim for increased ratings. He failed to appear for VA
audiometric evaluation. 38 C.F.R. § 3.159(c)(4) (2007).
There is no objective evidence indicating that there has been
a material change in the veteran's condition since the
claimant was last examined. 38 C.F.R. § 3.327(a) (2007).
The duty to assist does not require that a claim be remanded
solely because of the passage of time since an otherwise
adequate VA examination was conducted. See VAOPGCPREC 11-95.
The VA examination reports are thorough, the examinations in
this case are adequate upon which to base a decision, and the
records satisfy 38 C.F.R. § 3.326 (2007).
Further, the claimant's service treatment records and
pertinent post-service medical records have been obtained, to
the extent available. 38 U.S.C.A. § 5103A (West 2002 & Supp.
2007); 38 C.F.R. § 3.159 (2007). There is no indication in
the record that any additional evidence, relevant to the
issue decided herein, is available and not part of the claims
file.
In any event, the Board finds that any deficiency in the
notice to the claimant or the timing of these notices is
harmless error. See Overton v. Nicholson, 20 Vet. App. 427
(2006); (finding that the Board erred by relying on various
post-decisional documents to conclude that adequate 38
U.S.C.A. § 5103(a) notice had been provided to the claimant,
the Court found that the evidence established that the
claimant was afforded a meaningful opportunity to participate
in the adjudication of the claim, and found that the error
was harmless, as the Board has done in this case).
If any notice deficiency is present, the Board finds that the
presumption of prejudice on VA's part has been rebutted in
this case by the following: (1) based on the communications
sent to the veteran over the course of this appeal, the
claimant clearly has actual knowledge of the evidence he is
required to submit in this case; and (2) based on the
claimant's contentions as well as the communications provided
to the claimant by VA, it is reasonable to expect that the
claimant understands what was needed to prevail. See also
Simmons v. Nicholson, 487 F. 3d 892 (2007); see also Sanders,
supra.
Background
The veteran's service treatment records, including entrance
and separation examinations, show no complaints, treatment,
or diagnosis referable to hearing impairment. Whispered
voice testing at time of separation evaluation was 15/15.
These records do show that he fractured his left ankle in
November 1943 when he jumped off a tank. A cast was applied.
In July 1945, the veteran was involved in a jeep accident and
sustained multiple injuries, including moderate contusions of
both legs and a slight lacerated wound of the lower one-third
of the right leg. He was returned to duty in early August
1945. His separation examination reported a history of an
infected right leg but no current disability. Also reported
was a history of a fractured left ankle. No residuals were
noted.
Post service VA examinations in 1946, 1947, and 1950 showed
no complaints or clinical findings referable to the right leg
or left ankle. No hearing impairment was noted.
VA records from 1985 show that the veteran was hospitalized
for a right hip problem. Service connection for right hip
condition was denied by the Board in a March 1987 decision.
Subsequently dated VA records include outpatient treatment
records dated from 2002 through 2004. These records reflect
treatment for various conditions, to include hearing loss.
Additional VA examination of the ears in August 2004 resulted
in diagnosis of bilateral hearing loss, though the claims
file reflects that the veteran failed to report for actual
audiometric testing. The examiner noted that the veteran was
positive for noise exposure during combat. The diagnoses
included bilateral hearing loss and tinnitus. The examiner
opined that the veteran's tinnitus and hearing loss were most
likely due to noise exposure in military experience. Service
connection was established for tinnitus, and a 10 percent
rating was granted in the September 2004 rating decision from
which this appeal ensued.
VA examination of the lower extremities in August 2004 showed
no scars of either leg. No residuals of the infected right
leg were indicated. Similarly, no residuals of the left
ankle fracture were reported. There was full range of motion
of the ankles. Sensory was intact to both lower extremities.
The veteran complained of bilateral calf pain, and there
appeared to be claudication for which he was referred to
vascular surgery.
Service Connection - Bilateral Hearing Loss
Service connection may be established for a disability
resulting from personal injury suffered or disease contracted
in the line of duty or for aggravation of preexisting injury
suffered or disease contracted in the line of duty. 38
U.S.C.A. §1110 (West 2002 & Supp. 2007); 38 C.F.R. § 3.303
(2007).
Service connection may be granted for any disease diagnosed
after discharge, when all the evidence, including that
pertinent to service, establishes that the disease was
incurred in service. 38 C.F.R. § 3.303(d) (2007).
Where there is a chronic disease shown as such in service or
within the presumptive period under § 3.307 so as to permit a
finding of service connection, subsequent manifestations of
the same chronic disease at any later date, however, remote,
are service connected, unless clearly attributable to
intercurrent causes. 38 C.F.R. § 3.303(b) (2007).
This rule does not mean that any manifestations in service
will permit service connection. To show chronic disease in
service there is required a combination of manifestations
sufficient to identify the disease entity, and sufficient
observation to establish chronicity at the time as
distinguished from merely isolated findings or a diagnosis
including the word "chronic". When the disease entity is
established, there is no requirement of evidentiary showing
of continuity. When the fact of chronicity in service is not
adequately supported, then a showing of continuity after
discharge is required to support the claim. 38 C.F.R.
§ 3.303(b) (2007).
Continuous service for 90 days or more during a period of
war, or peace time service after December 31, 1946, and post-
service development of a presumptive disease such as
sensorineural hearing loss to a degree of 10 percent within
one year from the date of termination of such service,
establishes a rebuttable presumption that the disease was
incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West
2002 & Supp. 2007); 38 C.F.R. §§ 3.307, 3.309 (2007).
The Court has held that, in order to prevail on the issue of
service connection, there must be medical evidence of a (1)
current disability; (2) medical, or in certain circumstances,
lay evidence of inservice incurrence or aggravation of a
disease or injury; and (3) medical evidence of a nexus
between the claimed inservice disease or injury and the
present disease or injury. Hickson v. West, 12 Vet. App.
247, 253 (1999); see also Pond v West, 12 Vet. App. 341, 346
(1999).
The Board must assess the credibility and weight of all the
evidence, including the medical evidence, to determine its
probative value, accounting for evidence which it finds to be
persuasive or unpersuasive, and providing reasons for
rejecting any evidence favorable to the claimant. See Masors
v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2
Vet. App. 614, 618 (1992); Gilbert v. Derwinski, 1 Vet. App.
49 (1990). Equal weight is not accorded to each piece of
evidence contained in the record; every item of evidence does
not have the same probative value.
Analysis
Based upon the available evidence of record, the Board finds
it is not demonstrated that bilateral sensorineural hearing
loss was incurred during active service or within a one year
period thereafter. The first clinical evidence of such was
in 2002. This is many, many years after discharge from
active duty. While it is acknowledged that a VA examiner
opined in 2004 that the veteran's inservice noise exposure
was the likely cause of his hearing loss, the Board places
little probative value on the opinion. The examiner did not
address the over 50 year period that passed between discharge
and the initial report of hearing loss. Moreover, the
veteran failed to report for scheduled audiometric testing
that day, and the claim must be decided based upon the
available record. As such, the available evidence of record
which notes hearing loss but does not include any actual
audiometric testing reports, is not convincing that hearing
loss, first reported over 50 years after service, is of
service origin.
Moreover, to be considered for service connection for
defective hearing as a disability for VA purposes,
audiometric studies are needed. See 38 C.F.R. § 3.385. As
the veteran failed to report for the audiometric study, there
is no way to ascertain whether the veteran has a hearing
"disability" as defined for the VA. He indicated he had a
"hearing exam" at East Orange, but failed to provide
information concerning the date when asked. Thus no further
development is indicated.
The veteran may sincerely believe that he has bilateral
hearing loss as a result of service; however, he is not a
licensed medical practitioner and is not competent to offer
opinions on questions of medical causation or diagnosis. His
contentions as to etiology of this condition have been
considered. It is noted that he is competent as a lay person
to report on that which he has personal knowledge. See Layno
v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no
evidence of record that the veteran has specialized medical
knowledge to be competent to offer medical opinion as to
cause or etiology of the claimed disability. See Grottveit
v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2
Vet. App. 492, 494 (1992).
When all the evidence is assembled VA is then responsible for
determining whether the evidence supports the claim or is in
relative equipoise, with the claimant prevailing in either
event, or whether a preponderance of the evidence is against
the claim in which case the claim is denied. Gilbert v.
Derwinski, 1 Vet. App. 49, 55 (1990); Ortiz v. Principi, 274
F. 3d 1361 (Fed. Cir. 2001). The preponderance of the
evidence is against the claim.
Increased (Compensable) Ratings - Right Leg and Left Ankle
Disability evaluations are based upon the average impairment
of earning capacity as determined by a schedule for rating
disabilities. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2007);
38 C.F.R. Part 4 (2007). Separate rating codes identify the
various disabilities. 38 C.F.R. Part 4.
In determining the current level of impairment, the
disability must be considered in the context of the whole-
recorded history, including service medical records.
38 C.F.R. §§ 4.2, 4.41 (2007). The determination of whether
an increased evaluation is warranted is based on review of
the entire evidence of record and the application of all
pertinent regulations. See Schafrath v. Derwinski, 1 Vet.
App. 589 (1991). Where there is a question as to which of
two evaluations shall be applied, the higher evaluation will
be assigned if the disability picture more nearly
approximates the criteria for that rating. Otherwise, the
lower rating will be assigned. 38 C.F.R. § 4.7 (2007).
Additionally, the Board acknowledges that a claimant may
experience multiple distinct degrees of disability that might
result in different levels of compensation from the time the
increased rating claim was filed until a final decision is
made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The
analysis in the following decision is therefore undertaken
with consideration of the possibility that different ratings
may be warranted for different periods of time.
An evaluation of the level of disability present also
includes consideration of the functional impairment of the
veteran's ability to engage in ordinary activities, including
employment, and the effect of pain on the functional
abilities. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59 (2007);
DeLuca v. Brown, 8 Vet. App. 202, 204-06 (1995).
Under the laws administered by VA, the Secretary shall
consider all information and lay and medical evidence of
record in a case before the Secretary with respect to
benefits under laws administered by the Secretary. When
there is an approximate balance of positive and negative
evidence regarding any issue material to the determination of
a matter, the Secretary shall give the benefit of the doubt
to the claimant. 38 U.S.C.A. § 5107 (West 2002 & Supp.
2007); 38 C.F.R. § 4.3.
DC 7803 notes that unstable superficial scars are evaluated
as 10 percent disabling. Note (1) following indicates that
an unstable scar is one where, for any reason, there is
frequent loss of covering of skin over the scar. Note (2)
indicates that a superficial scar is one not associated with
underlying soft tissue damage. 38 C.F.R. Part 4 (2007). The
next criteria, that of DC 7804, provides that superficial
scars that are painful on examination are rated as 10 percent
disabling. Note (1) following states that a superficial scar
is one not associated with underlying soft tissue damage.
Note (2) states that in this case, a 10 percent evaluation
will be assigned for a scar on the tip of a finger or toe
even though amputation of the part would not warrant a
compensable evaluation (See 38 C.F.R. § 4.68 of this part on
the amputation rule). Finally, DC 7805 directs that other
scars shall be rated on the limitation of function of the
affected part. 38 C.F.R. Part 4 (2007).
Moderate limitation of motion of an ankle warrants a 10
percent evaluation. A 20 percent evaluation requires marked
limitation of motion. 38 C.F.R. § 4.71a, DC 5271 (2004).
The average normal range of motion of the ankle is from 20
degrees of dorsiflexion to 45 degrees of plantar flexion. 38
C.F.R. § 4.71, Plate II.
Analysis
The veteran's service-connected infected right leg is rated
pursuant to DC 7805 regarding scars. Residuals of a left
ankle fracture are rated pursuant to DC 5271 regarding range
of motion of the ankle. Service connection for these
conditions was granted upon rating decision in 1946.
Noncompensable ratings have been in effect since that time.
The veteran has appealed recent rating decisions which
confirmed and continued these noncompensable evaluations.
VA examination of the lower extremities in August 2004 was
negative for orthopedic problems associated with the right
leg or left ankle. No scar of the right leg was noted. The
veteran did appear to have vascular claudication, and he was
referred to vascular surgery. He had full range of motion of
the ankles.
Considering the record in light of the above-noted criteria,
the Board finds that the criteria for compensable ratings for
residuals of an infected right leg or residuals of a left
ankle fracture are not met. Actual residuals of these
service-connected disabilities are not indicated by the
current record. There is no evidence of recent active
infection. No scar is currently detected, and no limitation
of motion of the left ankle is indicated. The veteran's
vascular problems are not shown to be related to either of
these conditions.
Under these circumstances, the Board finds that the record
presents no basis for the assignment of schedular compensable
ratings under any applicable rating criteria for the right
leg or left ankle conditions.
Finally, it is noted that the Board has considered the
doctrine of reasonable doubt, but finds that the record does
not provide an approximate balance of negative and positive
evidence on the merits. Thus, the Board is unable to
identify a reasonable basis for granting the veteran's
claims. Also considered was referral of the case for the
assignment of an extraschedular rating under 38 C.F.R. §
3.321(b)(1), but the Board finds no basis for further action
on this question as there are no circumstances presented
which the Director of VA's Compensation and Pension Service
might consider exceptional or unusual.
ORDER
Service connection for bilateral hearing loss is denied.
An increased (compensable) rating for residuals of an
infected right leg is denied.
An increased (compensable) rating for residuals of a left
ankle fracture is denied.
____________________________________________
MICHAEL D. LYON
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs